AIPGMEE 2016 SurgeryMCQ

Postoperative fluid therapy
Q- 70 kg patient is 1 day following total hip replacement. He has not started
eating and drinking. He is being rehydrated with dextrose/saline (4% dextrose
and 0.18% saline). Which one of the following best describes this type of fluid
therapy?
A. It is an inappropriate fluid therapy for a postoperative patient
B. It contains 120 mmol of Na+ ions
C. Potassium supplementation is not required
D. Its osmolality is almost isotonic with plasma (286 mOsm/kg)
E. It has a pH of 7.35
\
Answer - D Its osmolality is almost isotonic with plasma (286 mOsm/kg)
Dextrose/saline is a useful fluid therapy in the early postoperative
period because it does not cause salt and water overload and provides
some energy to the patient. Dextrose/saline solution, otherwise known
as one-fifth normal saline, has an osmolality that is nearly isotonic
with plasma because of the 4% content of dextrose. It has a slightly
alkaline pH and contains approximately 30 mmol of sodium and chloride
ions. It does not contain K+ ions and so potassium supplementation
is important if the patient is not yet established on oral intake. It
predominantly replaces pure water losses that are common following
surgery. It is less useful in hypovolaemic resuscitation as it is a less
effective plasma expander than colloid or normal saline and in patients
who are losing excess salts.

AIPGMEE 2016

A recently deceased 92-year-old woman with a history of arrhythmia was discovered to have amyloid deposition in her atria upon autopsy. Upon further examination, there was no amyloid found in any other organs. The peptide at fault was identified and characterized by the pathologist performing the autopsy. Before its eventual deposition in the cardiac atria, which of the following functions was associated with the peptide? 

1.  Reduction of blood calcium concentration
2.  Antigen recognition
3.  Vasodilation 
4.  Slowing of gastric emptying
5.  Stimulation of lactation 

DISCUSSION: Upon autopsy, this patient was discovered to have amyloid deposits in the cardiac atria but interestingly in no other organs. By definition, this is isolated atrial amyloidosis (IAA) which is primarily caused by deposition of atrial natriuretic peptide (ANP) associated proteins. The function of ANP is vasodilation and reduction of total body sodium and water, through increased renal excretion. 

Amyloid is a generic term that refers to a group of diverse extracellular protein deposits. Although amyloids vary in amino acid sequence, all amyloid proteins are folded such that they share common ultrastructural and physical properties. All amyloids to be stain with congo red dye, which aids in diagnosis. Under polarized light, these deposits exhibit a red-green birefringence. In general, amyloidoses can be divided into systemic or isolated. By definition isolated amyloidosis is restricted to a single organ, as seen in this case as it is found only in the cardiac atria (isolated atrial amyloidosis).

Torricelli et al. report that alpha atrial natriuretic peptide is the protein responsible for isolated atrial amyloidosis upon histological evaluation of the myocardial tissue. This is unique to amyloid deposited only in the heart.

According to Steiner at al., autopsies reveal an 86% incidence of isolated atrial amyloidosis in those aged 81-90 years. This high frequency supports the idea that amyloid deposition is part of the senescence process of the heart. 

Illustration A shows a myocardial tissue biopsy with amyloid deposition. 
Illustration B shows a renal biopsy with congo red staining showing apple-green birefringence.

Incorrect answers:
Answer 1: Calcitonin reduces blood calcium and is commonly found in localized amyloidoses of the thyroid gland. 
Answer 2: Immune globulin light chain is involved in antigen recognition and causes multi-organ amyloid deposition that is not restricted to the cardiac atria.
Answer 4: Amylin slows gastric emptying and is found in localized amyloidoses in the pancreas.
Answer 5: Prolactin stimulates lactation and is found in localized amyloidoses of the pituitary gland.

HIV infection often results in MRI-detectable brain atrophy and white matter signal hyperintensities (WMSHs)

HIV infection often results in MRI-detectable brain atrophy and white matter signal hyperintensities (WMSHs).

 HIV+ patients compared to high-risk controls evidenced global atrophy, reduced caudate nuclei volume, and a trend to gray matter volume loss but no difference in white matter volume or in WMSHs. These effects were progressive with CDC clinical stage such that patients at CDC stage A had values very close to those of controls, while patients at CDC stage C had the most abnormal values. In contrast, the relationship between these MRI variables and severity of NP impairment was much less dramatic, with the mildly to moderately impaired HIV+ subjects showing MRI volume effects greater than or equal to those of the severely impaired HIV+ subjects. These results suggest that MRI-detectable brain atrophy secondary to HIV infection is not the primary substrate underlying the progressive NP impairment in HIV disease.

Neurocognitive disease associated with HIV infection has been separated into two categories: (1) a more severe form, HIV-1-associated dementia complex (HADC); and (2) a less severe form, HIV-1-associated minor cognitive-motor disorder.

 MRI-detectable brain atrophy is strongly associated with CDC stage of systemic HIV disease and much more weakly associated with severity of NP impairment. When HIV+ subjects were subgrouped by clinical stage, the MRI differences were directly and strongly associated with increasing severity of systemic disease.

 Opportunistic infections of the CNS remain the most common specifically identifiable source of neurologic disability 

AIPGMEE 2016 MCQ Medicine Neurology

A 34-year-old female complains of weakness and double vision for the last 3 weeks. She has also noted a change in her speech, and her friends tell her that she is “more nasal.” She has noticed decreased exercise tolerance and difficulty lifting objects and getting out of a chair. The patient denies pain. The symptoms are worse at the end of the day and with repeated muscle use. You suspect myasthenia gravis. All the following are useful in the diagnosis of myasthenia gravis EXCEPT:

A. Acetylcholine receptor (AChR) antibodies

B. Edrophonium

C. Electrodiagnostic testing

D. Muscle-specific kinase (MuSK) antibodies

E. Voltage-gated calcium channel antibodies

The answer is E.

(Harrison 18^th edn Chap. 386) Myasthenia gravis (MG) is a neuromuscular disorder characterized by weakness and fatigability of skeletal muscles. The primary defect is a decrease in the number of acetylcholine receptors at the neuromuscular junction secondary to autoimmune antibodies. MG is not rare, affecting at least 1 in 7500 individuals. Women are affected more frequently than men. Women typically present in the second and third decades of life, and men present in the fifth and sixth decades. The key features of MG are weakness and fatigability. Clinical features include weakness of the cranial muscles, particularly the eyelids and extraocular muscles. Diplopia and ptosis are common initial complaints. Weakness in chewing is noticeable after prolonged effort. Speech may be affected secondary to weakness of the palate or tongue. Swallowing may result from weakness of the palate, tongue, or pharynx. In the majority of patients the weakness becomes generalized. The diagnosis is suspected after the appearance of the characteristic symptoms and signs. Edrophonium is an acetylcholinesterase inhibitor that allows ACh to interact repeatedly with the limited number of AChRs, producing improvement in the strength of myasthenic muscles. False-positive tests may occur in patients with other neurologic diseases. Electrodiagnostic testing may show evidence of reduction in the amplitude of the evoked muscle action potentials with repeated stimulation. Testing for the specific antibodies to AChR are diagnostic. In addition to anti-AChR antibodies, antibodies to MuSK have been found in some patients with clinical MG. Antibodies to voltage-gated calcium channels are found in patients with the Lambert-Eaton syndrome.

AIPGMEE 2016 Tips for the students

Try to answer 75-100 macqs daily  of various subjects using materials from good coaching classes like TMCAA Thrissur http://www.tmcaa.org/
300days x100 = 30,000/year mcqs are sufficient for the good student to get a reasonably good rank.
If the keys are checked you may be able to get the questions where one went wrong.
Read only the topics where you went wrong.
2 hours per day is sufficient for attempting 100 mcqs per day

AIPGMEE 2016 MCQ O&G

The labia minora:
a. Contain similar nerve endings to the labia majora
b. Are derived from the same embryological structure as the labia majora
c. Have lymphatic drainage to the superficial and deep inguinal nodes
d. Contain sebaceous glands
e. Contain sweat glands

Answer
a. T-They are, however, less dense.
b. F-The labia minora develop from genital folds while labia majora develop from genital swellings.
c. T
d. T
e. T

AIPGMEE 2016 SPM MCQ

Question 1.

Regarding Rashtriya swasthya Bima yojana which is wrong?

a. government-run health insurance scheme

b. Every "below poverty line" (BPL) family holding a yellow ration card pays INR 30 registration fee

c. This enables them to receive inpatient medical care of up to INR 30,000

d. Pre-existing illnesses are not covered

Answer -D

Explanation-

government-run health insurance scheme

Every "below poverty line" (BPL) family holding a yellow ration card pays INR 30

This enables them to receive inpatient medical care of up to INR 30,000

Insured gets a biometric-enabled smart card containing their fingerprints and photographs

The scheme has won plaudits from the World Bank, the UN and the ILO as one of the world's best health insurance schemes

Pre-existing illnesses are covered from day one, for head of household, spouse and up to three dependent children or parents

This enables them to receive inpatient medical care of up to INR 30,000 per family per year in any of the empanelled hospitals

Pre-existing illnesses are covered from day one, for head of household, spouse and up to three dependent children or parents